Prognosis and Diagnosis of Advanced Melanoma
Michael B Atkins, MD, shares insights on the prognosis of patient’s diagnosed with advanced melanoma and discusses the value of BRAF mutation testing.
Case: A 62-Year-Old Female with Stage IV Melanoma
- A 62-year-old female consulted with her dermatologist for removal of a pigmented lesion that had recently become darker.
- She noted that she had been experiencing persistent fatigue, shortness of breath, and a dry cough that she attributed to a prior COVID-19 infection.
- LDH: 174 UI/L
- Excisional biopsy reveals melanoma with a Breslow depth of 1.2 mm, ulcerated, mitotic rate 4/mm2
- The patient underwent wide local excision and sentinel node mapping
- Staining was positive for melanoma in the right axillary node
- CT of the chest, abdomen, and pelvis indicated multiple lesions in both lungs
- The patient underwent core-needle biopsy of the largest lung lesion, measuring 1 cm
- Pathology revealed metastatic melanoma, cutaneous nonacral with a positive BRAF V600E mutation
- ECOG PS 1
- Diagnosis: Stage IV Melanoma, T2b N1a M1b
This is a video synopsis/summary of a Case-Based Peer Perspectives episodefeaturing Michael B. Atkins, MD.
In 2011, the median overall survival for patients with stage IV melanoma and M1B disease was 6 to 9 months, with only 10% to 20% alive at 2 years. Now with available therapies for metastatic melanoma, a patient with M1B disease has a 70% to 75% chance of 2-year survival and a greater than 60% 5-year survival, with most 5-year survivors off treatment and likely cured.
This 62-year-old woman represents a typical case. Median age in clinical trials is approximately 60 years. Lung metastases are a common first site, and brain metastases are rare at presentation. This raises the question of optimal treatment for the best chance of long-term survival.
Recommendations for such patients include getting a brain MRI, which this patient had, and testing for BRAF mutation. In contrast to lung cancer, only BRAF mutation analysis is typically needed, rather than more extensive next-generation sequencing that can take 2 to 3 weeks. A simple BRAF test can be done quickly with various methods to help guide treatment decisions about immunotherapy or targeted therapy choices. With rapidly progressive disease, targeted BRAF/MEK inhibitor treatment may help slow tumor growth more quickly than waiting several weeks for sequencing results.
Video synopsis is AI-generated and reviewed by Targeted Oncology® editorial staff.
